title: Percutaneous flexor tenotomy for preventing and treating toe ulcers in people with diabetes mellitus.
abstract: BACKGROUND
  The purpose was to examine the effectiveness of flexor tenotomy in a modified technique to prevent and heal neuropathic and neuroischaemic pressure ulcers on the tip of the toe in claw- or hammer-toe deformities in people with diabetes.
  
  
  METHODS
  A consequetive 4 years series of 38 patients was retrospectively studied. Percutaneous tenotomy on the superficial and deep flexor tendons was performed in 65 toes through a small transverse plantar stab incision just proximal to the web level. There were 16 (42%) patients with 27 ulcerated toes and 22 (58%) patients with 38 toes with impending ulceration. Ten patients had neuropathic ulcers and six patients had neuro-ischaemic ulcers. Sixteen patients (42%) had macrovascular disease. Ten (26%) had proliferative rethinopathy, 7 (18%) macroalbuminuria and 18 (47%) microalbuminuria.
  
  
  RESULTS
  All surgical incisions healed uneventfully. Twenty-five (93%) of the toe ulcers healed in median 21 days (range 7-224 days). Three patients had recurrence of the ulcer. There were no infections in the incisions or toe amputations. No patients treated with preventive tenotomy experienced toe ulceration. No complications were recorded in neuro-ischaemic ulcers. During the follow up period of median 31 months (range 2-48 months) 33 other ulcers were recorded in 18 patients (47%). One of these developed a transfer ulceration under the adjacent metatarso-phalangeal joint and another had a late pressure ulcer on a neighbouring toe. The other 31 ulcers were not related to ulcers treated with tenotomy.
  
  
  CONCLUSIONS
  Tenotomy is a simple, safe and effective procedure for preventing and treating distal plantar neuropathic toe ulcers in claw toe or hammer toe deformities in people with diabetes with or without serious co-morbidity. The results suggest that tenotomy should be considered also in neuroischaemic ulcers.
authors.affiliation: Steno Diabetes Center, Niels Steensens Vej 2-4, DK-2820 Gentofte, Denmark. aeru@steno.com
authors.forename: Anne
authors.initials: A
authors.lastname: Rasmussen
authors.forename: Ulla
authors.initials: U
authors.lastname: Bjerre-Christensen
authors.forename: Thomas Peter
authors.initials: TP
authors.lastname: Almdal
authors.forename: Per
authors.initials: P
authors.lastname: Holstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017719:Diabetic Foot / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012883:Skin Ulcer / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery*; D058971:Tenotomy / Q000379:methods*; D014034:Toes / Q000473:pathology*; D016896:Treatment Outcome
keywords: Claw toe/hammer toe; Diabetes mellitus; Diabetic foot wounds; Foot surgery; Neuropathic ulcers; Tenotomy; Ulcer prevention